Thursday, June 30, 2011

Have you caught the amazing, shocking, unbelievable news that type 2 diabetes can be managed through weight loss and lifestyle change?

I sure did.

Um, I first caught it in medical school nearly 20 years ago and see it virtually daily in my office.

I'm guessing if you've got type 2 diabetes, you caught that news from your doctor. In fact I'd be shocked to learn if there were a single type 2 diabetic on the planet who wasn't told at diagnosis that weight loss and/or lifestyle change could reverse the course of their disease, and while they'd need to maintain their losses/changes to maintain the reversal, that lifestyle can have at least as great an impact on disease course as drugs.

Well you see there was this study that got published in the journal Diabetologia. In it, the authors report that when 11 recently diagnosed, non-insulin dependent, type 2 diabetics were put on a low-carb, 600 calorie diet for 2 months, their diabetes magically disappeared, and that in 7 of them, by adhering to lifestyle/dietary changes, it stayed gone for an additional 3 whole months.

Wanna know what else disappeared for the participants?

Weight. In the first week they lost nearly 10lbs, or 5% of their presenting body weights. By the end of 8 weeks, they lost nearly 30lbs or 13% of their presenting body weights.

So is it surprising that a recently diagnosed type 2 diabetic who loses 30lbs living off an extremely low calorie, low carb diet, can come off of their oral hypoglycemics?

About as surprising as a lemon tasting sour.

What's perhaps more surprising than the fact that this study was published (small sample size, not even remotely surprising results, and an incredibly extreme and potentially dangerous intervention) was the authors' first line assertion,

Really? Who regards it that way? Certainly not any doctors I know. Every doctor I know counsels their patients that lifestyle management (weight and/or fitness) can mitigate risk, and in many cases, even reverse the condition.

But here's the biggest bee in my bonnet.

Studies on extremely low-calorie dieting very clearly state that the vast, vast majority of dieters regain all of the weight they so rapidly lose. We also know that ultra-rapid weight loss leads to disproportionate muscle loss, which in turn may help to explain why folks who lose weight extremely rapidly, when they inevitably head back to their old lifestyles, gain back more weight than they lost. What this means for these study participants, is that there's an extremely real likelihood that they'll not only gain back the 30lbs they lost as participants of this study, but that they'll gain back more. What they'll also almost certainly gain back is their type 2 diabetes, and this time, consequent to their disproportionately lost muscle mass, and their greater than before regain, may well require more, not less, medication to manage their resurgent disease.

Ethics should have stopped this study dead in its tracks.

Finally, the authors' enthusiastic conclusion about their work?

"It carries major implications for information to be given to newly diagnosed patients, who should know that they have a potentially reversible condition and not one that is inevitably progressive"

To me anyhow, that demonstrates an incredible lack of perspective, as not only have physicians been counseling their newly diagnosed, type 2 diabetic patients that their condition is potentially reversible with lifestyle change for decades, but the intervention recommended by the authors in this paper is in fact likely to lead to a regain of both weight and type 2 diabetes. Taking this one step further, I'd argue folks who follow these authors' amazing, shocking, unbelievable, major-implications approach, their diabetes will in fact be "inevitably progressive".

Tuesday, June 28, 2011

As a short track speed skater, Isabelle medaled in the 1994, 1998 and 2002 Olympic Winter games, and following her retirement from skating, she went on to complete her dietetic degree at the University of Montreal.

"Parents across Canada want to know that they're providing quality food to their families. Now you have a chance to see for yourself the real quality behind McDonald’s® food with the McDonald’s All-Access Moms Program."

Quality food?

In English speaking Canada, the program is being headlined by a celebrity nanny, Nanny Robina, but it's definitely French speaking McDonald's who have pulled off the marketing coup by landing not only a celebrity Olympian (aside from being named Canada's athlete of the year twice, Charest is currently part of a reality TV show highlighting elite athletes), but a mom, and an RD to boot!

Now I'm not the only blogger to notice All Access Mom's. Annie, from PhD in Parenting saw it and she submitted her own video application to become an all access mom. Email subscribers, click through to the blog, it's worth a quick watch.

All Access Moms is all about moms asking questions. The question I've got today is how does a celebrity Olympian RD rationalize her championing of a program whose ultimate goal is to get families out of their kitchens, and into an environment where "grilled chicken" actually means:

Monday, June 27, 2011

The first was that press release from CIHI, where its headline and first paragraph served here in Canada, to lead journalists to declare that all that's necessary to combat obesity are 15 minutes of exercise a day, and a diet rich in fruits and vegetables (and consequently anyone who's obese is lazy and eats Ding Dongs for supper).

It came from the University of North Carolina at Chapel Hill, and it was released in response to the cover story of this month's Obesity medical journal.

The press release was entitled, "New Study Highlights Perils of Snack-Filled Diet", and it made quite a splash, working its way through the Twitterverse, which in turn painted "snacking" as a dangerous behaviour for weight management.

Of course anyone who reads this blog will know that I'm a huge fan of snacking, and so I quickly clicked away at the links to see if maybe I'm wrong and that I should revamp my approach.

So what'd I find?

It had pretty much nothing to do with what I'd call, "snacking".

The article detailed the weight gain history of male Wistar rats, who for 15 weeks were fed one of 3 different diets: A high fat diet, a low fat diet, or a diet the researchers called the "cafeteria" diet, which in turn consisted of all you can eat chow, superimposed with, "3 human snack foods varied daily".

And guess what, rats who were offered unlimited amounts of human "snack" food 3x a day, ate a great deal more calories than their counterparts who were allowed to eat as much boring, unchanging, rat chow as they wanted.

Shocker, no? Rats given unlimited access to food almost certainly more palatable than that of their chow-eating counterparts, ate more.

But again I've got to come back to the question, what's a snack? After all, the press release has me worried that there are perils to my snack-filled diet.

For me a snack might be 25 almonds, or an apple along with an ounce of cheese, or some vegetables and hummus. I strive to have between 150 and 200 calories and a protein source each and every time I snack.

So is that what the rats were fed?

Nope.

Here's the list of foods to which the rats were given unlimited access:

So ultimately what this study showed was that caged rats love junk food.

Is that news? How this got published as a cover story for the reputable journal Obesity, rather than simply a footnote in the Journal of Duh, is beyond me (though the authors report the physiologic changes in the junk food fed rats mimic human physiologic changes with metabolic syndrome) , but more importantly, the press release out of the University of North Carolina at Chapel Hill, along with last week's from CIHI, has me wondering about the journalistic ethics of press releases, and the responsibilities of institutional PR departments.

I know that it's all about the headlines, but snacking, while certainly open to debate as to its utility in weight management (in the vein of multiple small meals vs. three square ones) simply wasn't the subject of this journal article. And in this day and age, where multitudes of people get their information in 140 character sound bites, and at best gloss over full press releases, and rarely if ever click through to actual journal articles, headlines matter even more. Folks reading the University of North Carolina at Chapel Hill's headline will take from it that their plan of healthy between meal snacks is a bad one.

Makes me wonder whether or not the rise of Twitter actually puts a greater onus on PR departments to issue non-misleading headlines, even if a truthful one such as, "New Study Highlights the Perils of Unlimited Junk Food Diets", wouldn't garner as many hits.

Perhaps PR departments and journalists should stop snacking on headlines and press releases and instead, eat the whole article before fairly reporting.

Thursday, June 23, 2011

I just received a very thoughtful email from Jeremy Veillard VP, Research and Analysis Canadian Institute for Health Information (CIHI) whose time and attention I certainly appreciate.

Here's are his thoughts, presented without commentary, regarding CIHI's recent report, and its reporting.

Dear Dr. Freedhoff,

Please feel free to share this response with your readers.

We have read your blog and the responses to it with interest, and wanted to clarify a few things about our Obesity in Canada report:

The goal of our report was to examine the prevalence and risk factors associated with obesity at a population level. It was never meant as a clinical tool, or to offer prescriptions at an individual level. For example, nowhere does the report or media release suggest that 15 minutes of exercise a day could eliminate obesity among Canadians. Our population-based analysis does however show that physical activity is one of the most important predictors of obesity after adjusting for other available risk factors (a point shared by Dr. Paul Boisvert on your blog).

Your point about caloric intake is taken. However, it is extremely difficult to measure and estimate caloric intake in general population-level health surveys such as the ones used for this report (especially using self-reported and recalled measures). We have therefore had to turn to the frequency of fruit and vegetable consumption as an approximation of diet quality. And while as you note, increased fruit and vegetable consumption does not equate with low caloric intake, it has been shown in other research to be a valid approximation of diet quality when exact measures of food intake are not available (see for example, Garriguet 2009 in Health Reports).

There is no question that obesity has risen quite dramatically over the past 30 years in Canada, and changes in activity and diet have played a role. The more complicated question then becomes, how do we create social and physical environments where healthy choices become the “easy choice” for Canadians? As part of the report release, we have conducted more than 30 interviews with media outlets across Canada and the message that we have been getting out is the same as yours: that obesity is complex and that a multi-faceted approach and policies are necessary to tackle it. The “spin” and over-simplification of the report’s findings are unfortunate. We are nevertheless pleased that the report has generated a healthy discussion on obesity across the country – including in blogs like this one.

Jeremy VeillardVP, Research and AnalysisCanadian Institute for Health Information (CIHI)

While the causes of societal weight gain, and difficulty of sustained losses, are highly complex, at the end of the day, calories are involved.

Whether you believe the primary problem's about intake or output, there's no disputing that weight's about caloric mismatch. No doubt there are hundreds of factors involved in eating behaviours and choices, but ultimately, regardless of your personal ranking of the prioritized importance of those factors in why and how they lead us to excess calories, weight's about excess calories. Whether we're eating more of them because of our shift from fats to carbs, whether we're eating more of them because of our increasing reliance on convenience and meals outside the home, whether we're eating more of them because our pace of life and styles of eating cultivate increased hormonal drives to eat, or whether we're simply burning less of them, whatever the cause, in the end, calories are the currency of information that will inform both treatment and prevention.

So how is it that the very basic currency of information isn't mentioned even once in the 62 page report that was just published by the Canadian Institutes of Health Information?

Instead of actually discussing calories, the report glosses over them. It uses the term "energy", and then talks about correlations. Correlations between obesity and physical activity levels, which they then qualify by stating that much of the data's unreliable due to the difference between self-reported and measured activity; and correlations between "poor diet" and obesity with some passing mention of again, "energy". By not actually addressing calories directly, the report perpetuates the myths that exercise burns lots of 'em, and that eating "healthy" is synonymous with "low calorie".

Couple that with the press release that steered all of the Canadian media, and subsequently the Canadian public, to believe that 15 minutes of exercising, and eating more fruits and vegetables, are going to solve this incredibly complex problem, and suddenly we've gone from potentially helpful, to almost certainly harmful.

Basically what the press release did was mislead the Canadian public about the causes and complexity of obesity, hamstring us in terms of caloric literacy (as 15 minutes of exercise burns negligible calories, and the consumption of fruits and vegetables doesn't preclude a high calorie diet), and perpetuate the myth that obesity is a disease of laziness and gluttony.

The worst part of it all?

The report itself, aside from what I see as a mind-boggling omission of a discussion of calories in terms of the reports' own identified determinants of weight, and a frankly misinformed attribution of benefit to negligible amounts of exercise and diets high in fruits and vegetables, does a pretty good job of describing the complexity involved. So instead of furthering Canada's understanding of obesity, CIHI's exercise and diet discussion, along with their inane and phenomenally misdirected press release, ended up perpetuating harmful obesity myths and individually blame based stereotypes.

Wednesday, June 22, 2011

You know how our Food Guide includes chocolate milk as a milk source (see photo up above)? And how that inclusion leads school boards, health organizations and health professionals to defend chocolate milk's consumption? And how that defense often leads to statements that suggest without chocolate milk, kids won't drink milk?

As chef Anne Cooper has noted, that's as nonsensical a message as stating without apple pie, kids won't eat apples.

Well one Edmontonian grade 4 class is having none of it. They've actually gone and started their own blog, The Milk Revolution. They've launched their blog in order to try to help their school reduce chocolate milk consumption by 60%.

So I've got to ask, why is it that Grade 4 students can muddle through the concept that beverages with 3.5 added teaspoons of sugar aren't beverages schools should be serving their students, while Canada's Food Guide explicitly includes chocolate milk as one of their recommended dairy choices?

They've released a few videos that bust some milk myths and in one of them, I came across this quote for Health Canada to consider,

"I'm no expert, but it doesn't take a genius to figure out added sugar isn't making a drink healthier. Kids have figured it out, what's wrong with the grownups?"

Kudos to Mrs. Swelander's Grade 4 class.

I've attached one of their videos below - email subscribers, you need to head over to the blog to watch:

Tuesday, June 21, 2011

Last week I was filmed by CTV for a piece on a new study. It aired a few nights ago. The piece was exploring a new "study" that is being reported as illuminating a link between stroller time in 1-5 year olds and childhood obesity.

Never you mind that the study failed to include an objective measurement of activity in these kids to determine actual levels of physical activity, never you mind that we don't have data on stroller use in the years before the rise of childhood obesity, never you mind that the calories burned even in active play for 1-5 year olds aren't much to write home about, never you mind that studies on childhood obesity clearly suggest it's not a problem of inactivity, and that in fact obesity leads to inactivity, not inactivity to obesity - none of those things matter because hey, childhood obesity's always news.

I know, we'd all dearly love to blame childhood obesity on kids moving less, but at best that's a minor player, and stroller use in 1-5 year olds wouldn't likely make the top 100 chart of cause contributors.

While I'm not remotely surprised this hit the newswires, I'm actually surprised with the spin I've been reading. The study, despite its many methodological limitations, specifically states,

"When adjusted for age, birth weight, nutritional risk, maternal BMI, and maternal PA, there was no association between stroller use and zBMI (p=0.50) or z-WC (p=0.23)."

Meaning that the study didn't in fact suggest or infer stroller time as causal for obesity.

There are plenty of places to point fingers in regard to childhood obesity. What a shame to waste good airtime on something that anyone who actually took the time to read the study knows doesn't in fact matter.

On the other side of the fence is a new paper published by Russel Lyons who posits that Christakis' and Fowler's work is a great example of statistical illiteracy, and that the conclusion drawn from their data, that obesity is socially contagious, is severely flawed and can't be made.

Lyons' paper, in a nutshell, gives statistical meat to my gut's firm belief - that shared environments and self-selection may well be explanatory for the clustering of obesity in social networks. That folks whose lifestyles may be more conducive to obesity, may well gravitate towards one another, and/or that people living in geographically/socially similar environments, environments that may contribute to the risk of obesity, together share increased risks and outcomes.

Statistical arguments aside (frankly they're way over my head and I couldn't begin to venture a guess who's right and who's wrong), what was most fascinating to me was Lyons' discussion of his paper's publication.

If Lyons' hypothesis is correct, his paper's a big deal. It refutes one of the most widely publicized studies of the decade, one that's translated itself into millions of dollars of grants, countless news stories, and even a book that's been published in 20 different languages.

So what happened when he tried to publish it?

The New England Journal of Medicine and the BMJ rejected it outright, without peer review. JAMA, the Lancet and the Proc. Nat. Acad. Sci. all rejected it next, this time because they have policies of not publishing critiques of articles they themselves didn't publish.

Next Lyons submitted his paper to a statistics journal. The journal, Stat. Sci., did send it out for peer review. 2 of the 3 referees recommended publication without revision, and the 3rd, clearly not an obesity researcher, stated that while they agreed with Lyons' conclusions, that the subject was not important enough to warrant publication. Stat. Sci.'s editors agreed with reviewer number 3, and rejected the paper.

Eventually Lyons' work was published in the journal Statistics, Politics, and Policy, whose impact factor rates at 0.857. Contrast that with the impact factor of 50 that the New England Journal of Medicine enjoys.

The entire experience has led Lyons to use his paper as a call to action to establish a journal whose subject matter is made up solely of study critiques. Were such a journal available, it would create a venue for publication of important criticisms, further protect the public from bad statistical analyses, and potentially serve as an incentive for researchers to double check their work.

All in all, even if you're not a statistician, Lyons' paper is worth a sober read and reflection, and here's something else to chew on - the journalists who were originally all over Christakis' and Fowler's work? I'd bet every last penny I've got that not a single one of them were skilled enough in statistical analysis to analyze it. Really, why should they have been? They're journalists, not statisticians. No, instead they smelled a good story, and ran with it. Those same journalists who shouted from the rooftops that obesity's contagious? I'm betting the vast majority of them are going to be silent on this one, yet wouldn't re-reporting be the socially responsible, ethical, and journalistic right thing to do?

Now I know that plenty of reporters read this blog. Would love to hear from you. Am I off base?

Thursday, June 16, 2011

I'm sad to report that our wonderful dietitian Shawna, after nearly 7 years, has decided it's time for her to move on to new challenges. She's moving to the eating disorder unit over at our local children's hospital and I'm sure she'll be a huge asset to their team.

What that means here of course, is that we're now on the hunt for a full-time RD to join our Ottawa office.

If you're not interested, but know someone who might be, please send this their way.

Thanks!

The Bariatric Medical Institute in Ottawa, a multi-disciplinary, holistic, nutrition and weight management centre that includes medical doctors, personal trainers, registered dietitians and a clinical psychologist is looking for a full-time dietitian to join our professional and unique team.

We are looking for someone who loves working with people, is great at multi-tasking, is a team player, thrives off of challenge and responsibility and wants to utilize his or her skills in making a dramatic positive difference in people’s lives. Our office is incredibly unique in that enrolment in our program provides patients with unlimited access to dietetic counseling and therefore you’ll have all the time in the world to actually steer people towards healthier lifestyles.

Responsibilities will include:

• Collaboration with multidisciplinary team members• Positive and non-restrictive approach to weight management• One-on-one counselling sessions to motivate and help patients live the healthiest lives they can enjoy (not the healthiest lives they can tolerate - we're not about under-eating and/or over-exercising).• Perform group discussions for general nutrition• Design individualized nutrition plans based on each individuals’ unique lifestyles, measured resting energy expenditures, and dietary likes and dislikes.

The skills you’ll need:

• Exceptionally strong motivational counselling skills• Must have excellent listening skills, empathetic and sensitive to patient’s needs. We do not ever utilize negative reinforcement in our counselling.• Able to adapt nutrition advice to recent scientific research with thoughtful critical appraisal• Must be innovative and give patients realistic and helpful nutrition advice• Comfortable giving presentations• Possess sound professional judgment, initiative and enthusiasm• Good time management skills and ability to organize• Good computer skills

The requirements we’re looking for:

• B.Sc in Nutrition• Completed internship• Member of governing provincial body and in good standing• Member of Dietitians of Canada and in good standing

Working with us you will have access to a full gym facility as well as shower and change rooms. Physical activity and healthy living are the primary focus of our work and therefore we view your active lifestyle as a great asset.

Salary will be competitive, medical and dental benefits after 3 months, and we're looking to hire sooner, rather than later, so if you're interested, pop that resume and cover letter into your outbox today!

Let's call the right hand the actual Heart and Stroke Foundation, a wonderful and important Canadian charitable institution.

So last week, the right hand, the Heart and Stroke Foundation, sent out their regular circular to physicians. In it was the nutrition facts panel up above which described how to read a food label.

Their sodium recommendations? Pretty staid, and certainly close to being in line with their signatory status on Blood Pressure Canada's Sodium Policy,

"Choose foods with sodium amounts less than 200mg per serving, or with a % Daily Value of sodium less than 10% (230mg)"

So now lets go back to their left hand, Health Check.

Looking at the 56 food categories where Health Check specifies sodium limits, only 9 are less than 230mg of sodium. That means 84% of foods the Heart and Stroke Foundation's own Health Check program scores allow per serving sodium levels higher than those recommended by the actual Heart and Stroke Foundation.

And that's of course, just the grocery store products. For restaurants, none of the 12 categories have maximums set at the level recommended by the Heart and Stroke Foundation. In fact the lowest rung on their restaurant ladder are side salads in which Health Check allows 360mg of sodium, and the top rung are meals that Health Check allows to ring in at 960mg, nearly 5x the Heart and Stroke Foundation's upper limit.

Right hand! Heart and Stroke Foundation! There's no shame in admitting when you've been wrong. Health Check is a nutritional laughingstock among nutrition and medical professionals, and frankly is a danger to consumers. Why not just put the damn thing of its misery, and do the right thing - stop encouraging Canadians to cook from boxes and eat out at restaurants, and put your considerable clout and trust to work helping to get Canadian families back to their dinner tables for home cooked meals made from real, whole, fresh, ingredients!

Wednesday, June 15, 2011

For my non-Canadian readers that photo up above is known as poutine, and it's French fries, smothered in cheese curds, smothered in gravy, and it's a bone of contention for Registered Dietitian Natasha McLaughlin-Chaisson.

Well poutine of course, and also Velveeta, and nachos with cheese. Kraft Dinner, pizza, and ice-cream make it onto the list too, albeit as lesser sources of calcium.

Now one way to read this, is that all Osteoporosis Canada is doing, is providing the calcium information of what they refer to as, "Common Foods" - foods we're eating anyhow.

Of course another way to read this is the way Natasha did, whereby she wonders whether or not their inclusion as high sources of calcium might represent an endorsement from Osteoporosis Canada, who in turn are nutritionally whitewashing the consumption of poutine, Velveeta, nachos and ice cream in the name of calcium.

Natasha's right, and I'll tell you why.

Natasha contacted Osteoporosis Canada with her concerns. After much run around she was told that the inclusion of the nachos and poutine will be looked at by a committee when they got a chance, but that one of their dietitians had approved their inclusions.

So? No slam dunk there, that doesn't mean their list is meant to encourage consumption or steer people to specific choices, it just means they've got a rather eccentric dietitian working for them.

Not quite. In fact the list is there to help Canadians navigate specific calcium sources as was evidenced by the fact that according to Natasha, they also told her that taking ice-cream off the list wasn't an option because,

"it is a good source of calcium especially with children who dislike milk"

Therefore it's indeed Osteoporosis Canada's list of "good" sources of calcium, as if it were just a list meant to serve to inform folks about the calcium content of common foods, that argument wouldn't have been put forth.

And what does the evidence say about dairy, children and bone mass?

Well a recent 2005 meta-analysis published in Pediatrics didn't think dairy was worthwhile, though critics will leap at the fact that it was authored by Neil Barnard, a known anti-dairy crusader. Of course there was also a 2006 BMJ meta-analysis that concluded pediatric calcium supplementation was also not helpful.

Personally, I can't imagine any proponents of dietary calcium (other than apparently Osteoporosis Canada) who would suggest calcium's so important that parents of non-milk drinking children feed it to them via ice-cream, or that adults should aim to get theirs from poutine, nachos and Velveeta.

And as far as adults go, ample evidence exists to suggest that increased dietary intake of calcium, doesn't seem to have any clinical impact on reducing the risk of osteoporotic fractures (see citations below).

The kindest thing I can say is that perhaps by including these foods Osteoporosis Canada is hoping that the increased weight of a person who eats them regularly will in turn serve to naturally increase their weight bearing activity - something that unlike dietary calcium, will most assuredly reduce their risk of osteoporotic fracture.

Calcium, Dairy Products, and Bone Health in Children and Young Adults: A Reevaluation of the Evidence, PEDIATRICS Vol. 115 No. 3 March 1, 2005 pp. 736 -74

Really ADA? Of all the healthy foods and beverages out there, the one you think should headline your new Men's Health page is beer? That's the super-food American men aren't getting enough of?

And what about the 15lbs a year that a beer a night could land you? Well don't you worry, the ADA has you covered there as also prominently featured on their new men's health page are articles like,

"Grill Your Way to a Six Pack"

and,

"Want to Get Lean? Eat Fat!"

Awesome!

Pretty soon all American men will look exactly like the guy in the photo up above - grilling our way to six packs, eating sausages and drinking kidney happy, bone strengthening, B-vitamin and fiber filled beer every night to relax!

Now I enjoy a BBQ and a cold beer as much (or more) than the next guy, but ADA, did you really think that just because you've got the words "men's health" on your new men's health page, that you had to come at men with the same sort of brilliance as Men's Health (the magazine)? No higher standards here.

Monday, June 13, 2011

One of the largest drivers of diet related chronic disease is misinformation, and the un-level playing field we enter every time we step foot in a supermarket.

With health claims, both overt and covert (implied), and governments that don't seem to care, consumers are left to fend for themselves in the face of Big Food's massive marketing machines.

Today's case in point?

New Chocolate Cheerios.

The box tries to sucker you in with,

"Whole grain guaranteed",

"Made with Real Cocoa",

and,

"May Reduce Risk of Heart Disease".

The website tries to bamboozle you with,

"One delightful serving of Chocolate Cheerios® has 9 grams of sugar and is a heart-healthy choice for your whole family."

and,

"Diets low in saturated fat and cholesterol may reduce the risk of heart disease"

Super-healthy! If you feed it to your family, they'll reduce their risk of heart disease, right?

Way better than the Froot Loops you grudgingly buy your kids, no?

No.

Let's compare. Spoon per spoon those, "healthy" Chocolate Cheerios contain identical amounts of sugar, 17% more calories, 40% more sodium, and 11% less fibre than Froot Loops, a cereal no one in their right mind would describe as "healthy".

Thursday, June 09, 2011

Prior to her celebrity status, she spent many years working with eating disordered patients and her doctoral thesis was on, "The Effects of an Eight Week Intuitive Eating Program on Eating Disordered Participants", and she reports that eating disorders are still part of her practice on her official biography.

While I know Dr. Berman recognizes many of the complexities of obesity in modern society, the average Joe/Jane doesn't. They don't think about the psychology of eating, socio-economics, co-morbid medical problems, predatory advertising, environmental obesogens, genetics, the cheap costs of calories, food hyperpalatability, lack of proper nutritional education in our schools, etc., etc. To them, societal obesity is a consequence of us spending too much time eating our proverbial, "chocolate sandwiches". They think it's all about laziness and gluttony, and that parents, "just saying no" and willpower would make this all go away. Though certainly not intentionally, Dr. Berman's tweet reinforced that message.

Given Dr. Berman's professional pedigree, I highly doubted that she meant for her tweet to be taken the way I've spun it above, so I contacted her via Twitter where she replied that was certainly not her intention.

That said, I wonder what her eating disordered patients, some of who also likely struggle with obesity, would think of her tweet, given that without a doubt many of them have seen their struggles amplified by health professionals who've callously and ignorantly, attributed their weights to the consequence of simply eating too many "chocolate sandwiches".

So why am I bothering with this post? Well maybe I'm over-reacting, but according to TweetReach, Dr. Berman's tweet reached nearly 200,000 people, and while certainly some may have taken that comment to be innocent, others certainly had it fuel their own ill-informed biases.

Given her profile, I'm guessing Dr. Berman's tweets carry more weight than the average, and here's hoping that she, and all of us who are enamored with 140 character updates, will remember to think about how those 140 characters might be interpreted before we tweet.

Wednesday, June 08, 2011

It's a form called, "Just the Basics", and presumably it's given to newly diagnosed Canadian diabetics by the Canadian Diabetes Association (CDA) to help them begin to understand and manage their disease.

Let's take a look at the bigger calories (though the "smaller" ain't so small):

Breakfast

600-700 calories

Lunch

800-900 calories

Afternoon snack

100 calories

Dinner

800-900 calories

Evening snack

600 calories

Total

2900-3200 calories

Thatsa lotta calories!

Furthermore, looking at their suggestions, it's boatloads of carbohydrates/sugars as well.

While calories certainly aren't the only nutritional determinant of health, given the impact of weight loss on glycemic control, and the impact of obesity on insulin resistance, I would suggest that the CDA ought to at the very least, provide, "just the basics", on calories as well.

Tuesday, June 07, 2011

A great many folks have been asking me to weigh in on the new American "food icon" My Plate that was launched last week.

First the good.

It's dead simple.

It's worlds better than the confusing pyramid it's replacing. It can theoretically actually help guide what a person might put on their plate without requiring them to wade through pages of reading (like Canada's Food Guide does).

Its simplicity is certainly its greatest strength.

Nutritionally though, it does fall down some, and while I could get into nitty gritty, I've only got three to really harp on starting with the full plate itself.

While it may sound ridiculous, I don't think that encouraging a full plate's a great plan. The fact is, we've got big plates, and while the accompanying website does provide caloric guidance, all the MyPlate icon does is suggest your plate should be full.

The second is that like our Food Guide, it doesn't provide much guidance as to the quality of different types of proteins, fats and carbohydrates.

Lastly, I don't think milk/dairy deserves it's own billing as dairy's just a protein source with calcium, and not a magic fairy food that confers the health of immortal unicorns.

But really, it's the broader picture stuff that really matters, as this food icon does nothing to actually address the underlying problems we've got nutritionally in society. It's for that reason why even if it manages to affect plate level changes, America will remain massively messed up nutritionally (not that we're any better).

For instance:

It doesn't address crop subsidies that make highly processed food incredibly cheap to produce and purchase.

It doesn't address the fact that on an annual basis the amount of food dollars we spend outside the home are growing.

It doesn't address the fact that home cooking is a dying art and that the food industry has hoodwinked many of us to believe that opening a few boxes and mixing things together actually counts as cooking.

It doesn't address the fact that we serve our children nutritional garbage in schools.

It doesn't address the nutritionism that among other ridiculousnesses, has folks championing chocolate milk as a means for kids to get calcium.

It doesn't address the front-of-package health claims that help to sell foods by means of their health haloing effects.

It doesn't address predatory targeting of children by Big Food manufacturers.

But of course, how could it?

Ultimately our respective Food Guides and Plates? They can't change the world they're being brought into, and until there's a concerted effort brought to bear to change our world, we aren't likely to see much in the way of useful dietary change.

Monday, June 06, 2011

Here in Canada we enjoy a single-payer health care system. What that means of course is that to protect our system, our government needs to regulate what doctors are and aren't paid for. Consequently, if there were a procedure that physicians were billing for that didn't have an evidence base to back it up, the Ministry of Health is obligated to put a stop to that practice.

Well I'm happy to report that as of June 1st, 2011, Ontario's Ministry of Health has ensured that our tax dollars will no longer be used to pay for vitamin injections, urinalyses or blood tests used in the context of rapid, medically supervised weight loss programs.

According to the Ministry,

"there is no evidence that vitamin injections facilitate weight loss and there is no evidence that rapid weight loss programs are effective in the long term"

What remains to be seen is whether or not the Ministry will determine that billing for patients visits as part of a rapid weight loss program will be denied as well. There's also the possibility that they will go after those clinics' physicians' past procedural billings as the onus would have been on the physician to know that the procedures they had been regularly billing for weren't in fact based in evidence.

I wonder too whether or not the Ministry's very unequivocal statement regarding the utility of vitamin injections in weight loss might lend itself to the development of class action lawsuits against those clinics or physicians who have provided those "treatments" in the past.

While the Ministry's decisions certainly aren't representative of a formal regulation or oversight of the weight loss industry, they're definitely a positive step in the right direction.

Thursday, June 02, 2011

Health Check, the woefully underpowered Heart and Stroke Foundation front-of-package program that encourages Canadians to consume processed foods and meals out, should listen to their social media folks.

Apparently Health Check has folks who are,

"listening online with an ear to conversations about eating habits, food sources and preparation, and nutritional hot points such as fat and sodium"

"Calories are the number one topic of conversation (32%) followed by fibre and carbohydrates (14% each), and sodium and fat (11% each). Other topics include added sugars, oils, cholesterol, and saturated and trans fats."

So let's see.

Is the nutritional determinant of health that Canadians are most concerned about online a determinant of Health Check?

Nope.

Sure, there are many things that go into an evaluation of whether a food's a healthy choice or not, but no doubt in a country where it's abnormal to have a healthy body weight, calories at least ought to be one of them.

Of course so should so many other things.

Generally Health Checks are awarded on the basis of a product's scores in only 3-5 different nutrient areas.

Contrast that with Nuval, a robust front-of-package program that scores more than 30 (including calories), and you might have a sense as to why I describe Health Check as woefully underpowered.

The Zoo, owned by the City of Toronto, is offering children under 12, free admission to the Zoo if they bring in a Coca-Cola product label.

And what will they get aside from admission?

"It will be a whole day of Coca-Cola® fun with sampling, prizes and more!"

Huzzah?

Should the City of Toronto really be helping to push, sell and polish a brand whose products are so excruciatingly linked to excess calories and childhood obesity, let alone in an event that explicitly targets kids under 12?

Horrifying, short-sighted, and just plain stupid.

Oh, and hey, Coca-Cola, I had a peek at your "commitment" regarding the Children's Advertising Initiative.

In it you state,

"We are committed not to directly market messages for any of our beverages to children under 12."

Hmmm. Wouldn't,

"a whole day of Coca-Cola® fun with sampling, prizes and more!",

at an event where your marketing hook is that kids under 12 get in free, constitute directly marketing your messages to the very population you're apparently "committed" to not directly market to?

Sigh.

Thankfully Coca-Cola, the copy of your commitment I looked at is electronic. I'm thankful of course, because it clearly wouldn't have been worth the paper I'd have had to print it on.

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About Me

Family doc, Assistant Prof. at the University of Ottawa, Author of The Diet Fix, and founder of Ottawa's non-surgical Bariatric Medical Institute - a multi-disciplinary, ethical, evidence-based nutrition and weight management centre. Nowadays I'm more likely to stop drugs than start them. You can also find me on Twitter and Facebook.

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